Sometimes when we are dealing with doctors who are not as familiar with the WC system, we have a difficult time getting them to address MMI, impairment ratings, etc…and complete the DWC-25..
Well the statute does provide us with some tools to help.
(This of course assumes the claimant is or should be at MMI, and the doctor doesn’t need to see them back for that determination (that’s a whole other tip)).
Under 440.13(4)(a), the authorized doctor SHALL send the carrier the DWC-25 within 3 business days and the narrative report within 15 days thereafter, or you don’t have to pay their bill. Pretty persuasive, but use this cautiously.
Here is the statute:
FL Stat 440.13 (4) NOTICE OF TREATMENT TO CARRIER; FILING WITH DEPARTMENT.—
(a) Any health care provider providing necessary remedial treatment, care, or attendance to any injured worker shall submit treatment reports to the carrier in a format prescribed by the department. A claim for medical or surgical treatment is not valid or enforceable against such employer or employee, unless, by the close of the third business day following the first treatment, the physician providing the treatment furnishes to the employer or carrier a preliminary notice of the injury and treatment in a format prescribed by the department and, within 15 days thereafter, furnishes to the employer or carrier a complete report, and subsequent thereto furnishes progress reports, if requested by the employer or insurance carrier, at intervals of not less than 3 weeks apart or at less frequent intervals if requested in a format prescribed by the department.
The “format prescribed by the department” is the DWC-25.
In FL Admin Code, it says the doctor needs to address MMI and the rating.
FL Admin Code 69L-7.730 Health Care Provider Medical Billing and Reporting Responsibilities.
(1) Bill Submission/Filing and Reporting Requirements.
(d) Insurers and health care providers shall utilize only the Form DFS-F5-DWC-25 for physician reporting of the injured employee’s medical treatment/status. No other reporting forms may be used in lieu of or supplemental to the Form DFS-F5-DWC-25.
- The Form DFS-F5-DWC-25 does not replace physician notes, medical records or Division-required medical reports.
- All information submitted on physician notes, medical records or Division-required medical reports shall be consistent with information documented on the Form DFS-F5-DWC-25.
- The DFS-F5-DWC-25, submitted to address the physical limitation(s), permanent impairment rating or maximum medical improvement date, shall be signed by the physician performing the physical examination upon which the physical limitation(s), permanent impairment or maximum medical improvement date is based.
And here is a copy of the DWC-25 instructions which says they must assign an impairment rating when the claimant is at MMI, and there can be no charge for completing the form itself:
Pick your battles with these, and it may be better handled with the doctor’s staff rather than the provider themselves.
Thanks, and as always send me any questions.
Morgan Indek | Partner